高渗盐水/右旋糖酐溶液对稳定型严重脓毒症患者的急性血流动力学效应

Acute haemodynamic effects of a hypertonic saline/dextran solution in stable patients with severe sepsis.

作者信息

Oliveira R P, Weingartner R, Ribas E O, Moraes R S, Friedman G

机构信息

Universidad Federal do Rio Grande do Sul, Porto Alegre, Brazil.

出版信息

Intensive Care Med. 2002 Nov;28(11):1574-81. doi: 10.1007/s00134-002-1509-x. Epub 2002 Oct 1.

DOI:10.1007/s00134-002-1509-x

PMID:12415443

Abstract

OBJECTIVE

To study the haemodynamic effects of a hypertonic saline/dextran solution compared with a normal saline solution in patients with severe sepsis.

DESIGN

Prospective double blind and control-randomised study.

SETTING

Adult intensive care unit in a university hospital.

PATIENTS

Twenty-nine patients with sepsis with a pulmonary artery occlusion pressure (PAOP) lower than 12 mmHg.

INTERVENTIONS

Patients were randomised to receive 250 ml of blinded solutions of either normal saline (SS group, n=16) or hypertonic saline (NaCl 7.5%)/dextran 70 8% (HSS group, n=13) solutions.

MEASUREMENTS AND RESULTS

Haemodynamic, blood gas, and sodium data were collected at the following time points: baseline, 30 min, 60 min, 120 min, and 180 min. PAOP was higher in the HSS group at 30 min (10.7+/-3.2 mmHg vs 6.8+/-3.2 mmHg) and 60 min (10.3+/-3 mmHg vs 7.4+/-2.9 mmHg); P<0.05. The cardiac index increased in the HSS group and it was greater than the SS group at 30 min (6.5+/-4.7 l min(-1) m(-2) vs 3.8+/-3.4 l min(-1) m(-2)), 60 min (4.9+/-4.5 l min(-1) m(-2) vs 3.7+/-3.3 l min(-1) m(-2)), and 120 min (5.0+/-4.3 l min(-1) m(-2) vs 4.1+/-3.4 l min(-1) m(-2)); P<0.05. The stroke volume index followed a comparable course and it was higher at 30 min [53.6(39.2-62.8) ml m(-2) vs 35.6(31.2-49.2) ml m(-2)] and 60 min [46.8(39.7-56.6) ml m(-2) vs 33.9(32.2-47.7) ml m(-2)]; P<0.05. Systemic vascular resistance decreased in the HSS group and became significantly lower at 30 min (824+/-277 dyne s(-1) cm(-5) m(-2) vs 1139+/-245 dyne s(-1) cm(-5) m(-2)), 60 min (921+/-256 dyne s(-1) cm(-5) m(-2) vs 1246+/-308 dyne s(-1) cm(-5) m(-2)), and 120 min (925+/-226 dyne s(-1) cm(-5) m(-2) vs 1269+/-494 dyne s(-1) cm(-5) m(-2)). Sodium levels increased in the HSS group (P=0.056) and were higher than in the SS group at 30 min (145+/-3 mEq l(-1)vs 137+/-7 mEq l(-1)), 60 min (143+/-4 mEq l(-1) vs 136+/-7 mEq l(-1)), 120 (142+/-5 mEq l(-1)vs 136+/-7 mEq l(-1)), and 180 min (142+/-5 mEq l(-1) vs 136+/-8 mEq l(-1)).

CONCLUSION

Hypertonic saline/dextran solution may improve cardiovascular performance in severe sepsis without significant side effects. The haemodynamic effect appears related mainly to a volume effect.

摘要

目的

研究高渗盐水/右旋糖酐溶液与生理盐水相比，对严重脓毒症患者的血流动力学影响。

设计

前瞻性双盲对照随机研究。

地点

大学医院的成人重症监护病房。

患者

29例脓毒症患者，肺动脉闭塞压（PAOP）低于12 mmHg。

干预措施

患者被随机分为两组，分别接受250 ml盲法配制的溶液，一组为生理盐水（SS组，n = 16），另一组为高渗盐水（7.5%氯化钠）/70 8%右旋糖酐（HSS组，n = 13）。

测量与结果

在以下时间点收集血流动力学、血气和钠数据：基线、30分钟、60分钟、120分钟和180分钟。HSS组在30分钟时PAOP较高（10.7±3.2 mmHg对6.8±3.2 mmHg），60分钟时也较高（10.3±3 mmHg对7.4±2.9 mmHg）；P<0.05。HSS组心脏指数升高，在30分钟时高于SS组（6.5±4.7 l min⁻¹ m⁻²对3.8±3.4 l min⁻¹ m⁻²），60分钟时（4.9±4.5 l min⁻¹ m⁻²对3.7±3.3 l min⁻¹ m⁻²），120分钟时（5.0±4.3 l min⁻¹ m⁻²对4.1±3.4 l min⁻¹ m⁻²）；P<0.05。每搏量指数变化趋势相似，在30分钟时更高[53.6(39.2 - 62.8) ml m⁻²对35.6(31.2 - 49.2) ml m⁻²]，60分钟时[46.8(39.7 - 56.6) ml m⁻²对33.9(32.2 - 47.7) ml m⁻²]；P<0.05。HSS组全身血管阻力降低，在30分钟时显著低于SS组（824±277 dyne s⁻¹ cm⁻⁵ m⁻²对1139±245 dyne s⁻¹ cm⁻⁵ m⁻²），60分钟时（921±256 dyne s⁻¹ cm⁻⁵ m⁻²对1246±308 dyne s⁻¹ cm⁻⁵ m⁻²），120分钟时（925±226 dyne s⁻¹ cm⁻⁵ m⁻²对1269±494 dyne s⁻¹ cm⁻⁵ m⁻²）。HSS组钠水平升高（P = 0.056），在30分钟时高于SS组（145±3 mEq l⁻¹对137±7 mEq l⁻¹），60分钟时（143±4 mEq l⁻¹对136±7 mEq l⁻¹），120分钟时（142±5 mEq l⁻¹对136±7 mEq l⁻¹），180分钟时（142±5 mEq l⁻¹对136±8 mEq l⁻¹）。